tbuckley/cabot-search huggingface dataset:
COVID-19 admissions among patients with cancer, characterization, and at-home monoclonal antibody treatment.
Authors: Amy Iarrobino Laughlin, Allison Steyl, Beth Ingle Emsley, Terra Warner, Andrea Ledford, Richard M Basaly, Sara Y Baker, Margo Shoup, Akash Nanda, Nicholas George Avgeropoulos
Journal: Journal of Clinical Oncology (2022)

414 Background: Cancer patients are at risk for severe Covid-19 infection. We characterized Covid-related hospitalizations across a large health system in Central Florida. We then used this analysis to target at home treatment for Covid-19. Methods: Retrospective chart review was conducted for all Covid-related admissions in cancer patients 1/2021-7/2021 at Orlando Health. Cancer type, discharge, vaccination and treatment status were collected. Distribution of cancer type among patients admitted was compared to the population treated at the cancer institute using chi-square test. Casirivimab and imdevimab monoclonal antibody (intravenous or subcutaneous) was provided at home through partnership with a home health agency. All patients received follow-up for patient satisfaction and resolution of symptoms. Results: 104 patients with Covid-related admissions were identified. 83% were diagnosed with solid and 17% with hematologic malignancy. The most common cancers were breast, genitourinary, lung, head and neck and upper gastrointestinal cancers. Proportion of patients with hematologic malignancies (lymphoma, leukemia, myeloma) were significantly higher among Covid admissions compared to the population of patients treated at the cancer institute (19/104 versus 320/4127, p &lt; 0.01). 9% of patients died in hospital. 91% were discharged alive, 72% to home. 78% were unvaccinated (15% two, 7% one dose). 30% were on active treatment within 90 days, 52% received cytotoxic agents, 48% received targeted therapy or immunotherapy. Oncology clinics caring for hematologic malignancy patients were then targeted to offer Covid treatment at home.18 patients requested treatment from 8/17/21-10/25/21. 13 patients were treated at home, 1 went to the emergency room before receiving therapy and 4 were denied by insurance. Patients and providers were highly satisfied, with net promoter scores of 85 (n = 13) and 100 (n = 7) respectively. No infusion reactions occurred. Follow-up with all patients indicated resolution of symptoms, no patients were hospitalized for Covid after 7 days. Conclusions: Covid admissions among cancer patients at a large health system were consistent with published reports noting increased risk for patients with hematologic malignancies. Identification of this population translated to a targeted approach to offering monoclonal antibody treatment at home. In this small cohort, at home treatment was safe and associated with high patient and provider satisfaction.
Identifying sources of burnout among clinicians at a cancer center: A qualitative analysis.
Authors: Oliver Nguyen, Amir Alishahi, Colin Evan Moore, Randa Perkins, Jennifer Bickel Young, Dorte Heimbeck, Kea Turner
Journal: Journal of Clinical Oncology (2022)

429 Background: Clinician burnout leads to increased job turnover and workforce shortages, and reduced patient satisfaction and quality of care. Despite its importance, there has been limited study of burnout among the cancer care workforce including sources of burnout. This information can be used to inform intervention design for use in the cancer care setting specifically. To address this gap, we analyzed open-ended responses to a well-being survey administered to clinicians (physicians and advanced practice providers) at a Cancer Center. Methods: In February 2022, we electronically administered the American Medical Association’s clinician well-being survey to all practicing clinicians at a National Cancer Institute-designated Comprehensive Cancer Center in Florida. Of 700 clinicians, 405 (58%) responded. Of the respondents, 259 (64.0%) answered the free-text question “Tell us more about your stressors and what we can do to minimize them.” We used in-vivo coding to develop qualitative themes across responses. If a given response incorporated multiple themes, we coded the response under all pertinent themes. Results: A majority (76/259) of respondents commented on staffing issues, such as their clinics being understaffed or the quality of current staff. Another frequent theme (64/259) was the electronic health records (EHR) system, such as lack of integration between modules, inbox fatigue, alert fatigue, and inefficient documentation review processes. Respondents also reported scheduling issues as a pain point (56/259), such as having schedules that do not reflect actual clinical practice, being overbooked, and scheduling errors. Documentation burden was also highlighted as an issue across respondents (34/259). Documentation was considered tedious and some respondents reported a mismatch between available documentation tools in the EHR and actual documentation needs. Less common themes reported across respondents included design issues of facility space (e.g., no dedicated workspace to complete work without interruptions) and insufficient time to complete administrative, research, and documentation requirements. Conclusions: Our findings suggest that interventions that optimize staffing models, EHR processes (e.g., documentation), and scheduling practices may reduce burnout for a considerable number of cancer care clinicians.
Real-world use and clinical impact of electronic patient-reported outcomes (ePROs) in patients with solid tumors treated with immuno-oncology (IO) therapy.
Authors: Natalie R. Dickson, Karen D. Beauchamp, Toni S. Perry, Ashley Roush, Deborah Goldschmidt, Marie Louise Edwards, L. Johnetta Blakely
Journal: Journal of Clinical Oncology (2022)

416 Background: Patients with cancer can experience disease- and treatment-related symptoms that are underreported and underestimated by physicians. This observational, non-interventional study evaluated the use of ePROs and their impact on duration of treatment (DoT) in patients with solid tumors receiving IO therapy in community practice. Methods: Patients initiating index IO therapy immediately prior to (Jan-2017 to Dec-2018) and after (Sep-2019 to Dec-2020) implementation of Noona, the ePRO platform at Tennessee Oncology clinics, were included in a retrospective historical control (HC) and ePRO cohort, respectively, and followed for up to 6 months. The ePRO cohort was further divided into ePRO users (platform enrollment ≤45 days from index) and non-users. ePRO questionnaires, based on Common Terminology Criteria for Adverse Events (CTCAE), were sent within a week after each IO infusion and could be completed using an internet browser or smartphone app. Patient characteristics and DoT were described and compared between the HC and ePRO cohorts and between the HC cohort and ePRO users subgroup. Use of ePROs was evaluated within the ePRO cohort. Differences in baseline characteristics between cohorts were adjusted using Cox proportional hazards models. Results: Data were collected for 538 HC and 1014 ePRO patients (319 ePRO users and 695 non-users). Patient characteristics were generally similar between cohorts, but more HC patients were diagnosed with Stage IV disease (54% vs 47%; p &lt; 0.01) and initiated IO as monotherapy (82% vs 52%), while more ePRO patients initiated IO as combination therapy (48% vs 18%). ePRO users were more likely than non-users to be female, white, married, living with a spouse, and have higher education (college or graduate degree) (all p &lt; 0.05). Use of ePROs was durable over follow-up, with a consistent number of questionnaires sent over Months 1-3 and Months 4-6 (median: 6 questionnaires in each period) and a slight decrease in the number answered (median: 4 vs 3 questionnaires). ePRO patients had a longer DoT than HC patients (median time to end of first IO regimen: not estimable vs 5.1 months). Significantly more ePRO than HC patients remained on their first IO regimen at 6 months (54% vs 46%; p &lt; 0.05). Multivariate Cox regression showed the risk of ending first IO therapy was lower for ePRO versus HC patients (p &lt; 0.05). Conclusions: The increased DoT observed in the ePRO versus HC cohort in this study suggests that use of ePROs may facilitate improved care coordination and enable patients to remain on IO therapy longer. However, ePRO uptake was only 31% in the ePRO cohort, with several social determinants appearing to influence use. Overcoming barriers in ePRO uptake is an area for future study.
Evaluation of initiatives including an EHR prompt (EP) and APP involvement to increase germline genetic testing compliance in a pancreatic cancer population.
Authors: Rebecca Ronnen, Rachel Carroll, Lauren Kiley, Melissa Cruz-Tanner, Rosemary Montes, Sameer P. Desai
Journal: Journal of Clinical Oncology (2022)

302 Background: Germline genetic testing is now recommended for all pancreas cancer patients (pts); identification of a BRCA1/2, ATM or PALB2 mutation can impact upfront and/or second line therapy. These mutations have been found in approximately 4-11% of prior reports of pancreatic cancer populations. Previous reports have found that genetic testing is done in a minority of patients, especially in private practice. This project assesses how two interventions on physician behavior can impact the frequency of germline genetic testing in pancreas cancer patients in a multi-office private practice setting. Methods: Retrospectively, we used algorithms in Flatiron’s OncoEMR to identify baseline germline genetic testing frequency in all pancreas cancer patients. In phase 1, we used an EP to communicate with doctors immediately before upcoming appts for their pancreas cancer pts. In phase 2, advanced practice providers (APPs) educated pancreas cancer patients about germline genetic testing and ordered the test ahead of the patients’ visits. Our primary endpoint was to determine the percentage of pancreas cancer patients who had germline genetic testing; our secondary endpoint was to determine frequency of BRCA/PALB2/ATM mutations. Results: Retrospectively, 82 pancreas cancer pts were identified from 6/1/2020 - 1/1/2021. 32 pts (39%) had germline genetic testing. Prospectively, in phase 1, 35 pts with pancreas cancer and upcoming appointments were identified between 6/28/2021 - 8/6/2021. 21 (60%) had previously had germline testing. Of 14 patients who had not had testing, the EP prompted additional testing of 7 (50%) pts. Of the total 35 pts in phase 1, 2 (5.7%) were found to have mutations. In phase II, 47 of 74 pts (63%) had previously had germline testing, and APP intervention resulted in 19 of 27 patients (70%) receiving germline testing, with 5 (6.7%) found to have BRCA1/2, PALB2 or ATM mutations of the 74 patients. Conclusions: Our results reveal that while APP education and ordering of germline genetic testing is slightly more effective than involving the doctors in the process, further improvement is needed. Utilizing the EMR when a diagnosis code is entered and then automating genetic counseling and ordering for these patients will be needed. Lastly, a team based approach with navigators involved in rounding will also improve testing frequency even with more automated testing. While our % of patients with an actionable mutation is low, given the options it opens for these patients, universal testing is still warranted.
Improving participation of under-represented minorities in breast cancer therapeutic trials in a safety-net system.
Authors: Nasir Qureshi, Fabian E. Robles, Nisha Unni, Samira K. Syed, Hsiao Ching Li, Navid Sadeghi
Journal: Journal of Clinical Oncology (2022)

90 Background: Racial and ethnic minorities remain under-represented in cancer clinical trials. Strategies to improve access and participation of diverse populations in clinical trials is therefore a key step to improve outcomes and eliminate disparities. Methods: Parkland Health (PH) is the safety-net system for Dallas County, Texas, and is affiliated with the UT Southwestern/Harold C. Simmons Comprehensive Cancer Center (SCCC). Trial operations at PH is mainly supported by a dedicated team of SCCC research coordinators. Interventions employed to increase minority access and accruals were focused on optimizing the portfolio, increasing provider awareness, and enhanced screening. A bilingual research patient navigator was also added to the research team to improve patient education and engagement. Transportation and childcare assistance are routinely provided for patients at PH. Accrual data for 2021, compared to 2017-2020, is presented here. Results: The majority (73%) of breast cancer patients at PH are uninsured and 88% belong to racial/ethnic minorities (57% Hispanics, 31% Blacks). Of the 15 therapeutic breast cancer trials open at SCCC in 2021, 12 (80%) were open at PH. The PH breast cancer trial portfolio included 4 cooperative group, 5 industry-sponsored (ISTs), and 3 investigator-initiated studies (IITs). Four trials were in metastatic setting and 8 were in curative intent setting. Four trials required a genomic biomarker. Forty-three patients were enrolled in therapeutic trials at PH in 2021. This represents 10.3% (43/418) of new cases during the same time period. Thirty-two were enrolled in cooperative group studies, 10 in IITs, and 1 in ISTs. The majority (93%) of the trial participants belonged to under-represented minorities. Number of trial participants in 2021 increased by 48% compared to the best year in the past 5 years (29 patients enrolled in 2018). Conclusions: Collaboration between academic institutions and safety-net systems presents a unique opportunity to provide clinical trial options to under-represented minorities. In this setting, interventions to improve trial portfolio, provider awareness, screening process, and patient education, as well as addition of a patient research navigator resulted in a significant increase in the number of minority participants in breast cancer trials at our safety-net hospital.
Assessment of Spanish hospitals involved in the Quality Oncology Practice Initiative program.
Authors: Jesus Garcia-Foncillas, Rafael Lopez, Carlos Camps, Vicente Guillem, Jose Luis Alonso, Alfredo Carrato, Nicole Martín, Luis G. Paz-Ares, Mariano Provencio, Emilio Esteban, Francisco Ayala, Pedro Pérez-Segura, Javier Narbona, Juan L. Bayo, Maria Bessa, Paula Gratal
Journal: Journal of Clinical Oncology (2022)

305 Background: Measuring and tracking quality of care is highly relevant in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. The ECO Foundation (Excellence and Quality in Oncology), a collaboration of oncology experts from the major Spanish hospitals involved in cancer treatment, reached an agreement with ASCO (American Society of Clinical Oncology) to include Spanish hospitals in its QOPI program. Methods: We analyzed the scores of the QOPI rounds from 14 Spanish hospitals, which submitted their charts from 2016 to 2021, and the measures obtained from 2018 to 2021, regarding the core/symptom, breast, colorectal (CRC) and NSCLC modules, in comparison with the QOPI aggregate measures. Results: Since 2016, 14 Spanish hospitals have participated in the QOPI program, achieving the certification 12 of them, and 3 are in process. Along the years, they have obtained a score over 85%, being 87,41% the worse in 2021, and 92,80% the best in 2020. We also analyzed the outstanding measures from 2018 onwards. The highest scores in Spanish hospitals were for information of infertility risks and chemotherapy intent prior to prescription, and documented plan for oral chemotherapy. However, measures regarding pain addressed, appropriate antiemetic therapy for high- and moderate-emetic-risk antineoplastic agents and action taken to address problems with emotional well-being by the second office visit, were among the lowest scored measures. When we focused in breast and NSCLC modules, Spanish hospitals didn´t show negative values, highlighting in the administration of Tamoxifen or AI within 1 year of diagnosis by patients with AJCC Stage IA (T1c) and IB - III ER or PR positive and in the status documentation for patients with initial AJCC Stage IV or distant metastatic NSCLC. In CRC module, Spanish hospitals showed lower scores in colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy. Conclusions: This study evaluates QOPI scores in Spain, showing that repeated participation enhances quality of care, although there is room for improvement. ECO Foundation will continue supporting Spanish practices to increase their participation aiming of improve oncology care in Spain.
Health insurance coverage patterns before and after a cancer diagnosis: Findings from adult patients with cancer in an integrated health system.
Authors: Matthew P. Banegas, John F. Dickerson, Amanda F. Petrik, Melissa L. Anderson, Arvind Ramaprasan, Erin Keast, Jamie Wallace, Nora B. Henrikson
Journal: Journal of Clinical Oncology (2022)

262 Background: Patients diagnosed with cancer experience intense medical care and high costs associated with the disease and its treatment. As a result, patients may consider changes to their health insurance coverage to adjust the medical benefits covered and/or the cost-sharing (e.g., annual maximum out-of-pocket [MOOP] limit) requirements. The purpose of this study was to assess the patterns of health insurance plan coverage patterns prior to and following a diagnosis of cancer among adult patients. Methods: Data from 13,237 patients aged ≥18, enrolled at Kaiser Permanente Northwest, diagnosed with cancer between Jan. 1, 2016–March 31, 2021 [index cancer], with ≥12 months of continuous health insurance coverage pre-cancer diagnosis were included. Patients enrolled in hospice prior to index cancer were excluded. Health insurance coverage outcomes included (1) coverage patterns (maintenance, interruption, termination, switch); (2) a composite of any coverage changes; and (3) cost-sharing patterns. Monthly health plan membership enrollment data was used to assess outcomes between two time periods: pre-diagnosis (12 months prior to index cancer) and post-diagnosis (12-18 months following index cancer). Patient sociodemographic, enrollment, health plan and clinical data were extracted from the electronic health record (EHR). Descriptive statistics were used to assess outcomes. Results: Approximately 40% of patients were ages 18-64, 54% were female and 9% were non-White. At index cancer diagnosis, 60% of patients had Medicare, 37% had a commercial plan and 3% had Medicaid. Among patients aged 18-64, 62% had any change in health insurance coverage between pre- to post-cancer diagnosis, including 41% who switched plans, 19% who terminated and 2% with an interruption. Among patients aged 65+, 50% of patients had any change in health insurance coverage, including 20% who switched plans, 30% who terminated and &lt; 1% with an interruption. For those who switched plans between the pre- to post-diagnosis periods, the most common patterns included switching out of commercial plans (-11% points) and switching into either Medicare (+9% points) or Medicaid (+5% points). Among all patients, 14% changed to a higher cost-sharing plan (difference in mean individual, in-network MOOP limit: $938) and 10% changed to a lower cost-sharing plan (difference in mean individual, in-network MOOP limit: -$1701). Conclusions: Our novel findings provide valuable information about health insurance plan coverage patterns among adults diagnosed with cancer and suggest a large proportion of patients may undergo changes to their health insurance coverage. Future studies that assess the implications of health insurance changes on care access and cancer outcomes are warranted.
Improving routine use of clinical pathway decision support through EMR integration.
Authors: Dinesh Kotak, Mary Mitsuko Ichiuji, Laura Asakura, Shawn Hanifin, Nancy Aye, Tatjana Kolevska, Carol Cain, Violeta Rabrenovich, Mark Lindberg, Yan Li
Journal: Journal of Clinical Oncology (2022)

432 Background: There has been an explosive growth in oncology with an evolution of precision oncology based on molecular profiling. Providing evidence-based, high quality, equitable care is a foundational mission for Kaiser Permanente (KP). Thus, KP created a systematic approach toward oncology care pathways that incorporated organizational leadership, structured participation and feedback, novel integration of clinical decision support (CDS) tools, and evaluation of efficacy, safety, and value. Our goal was to make it easy and preferable for physicians to access clinical decision support for every patient, every time. Methods: KP’s inter-regional oncology chiefs, supported by relevant teams in evidence analysis, pharmacy, and other clinical specialties, convened monthly meetings in 10 oncology sub-specialties to synthesize evidence and create care pathways for priority conditions. The pathways are published to KP’s Clinical Library (CL), a trusted, curated resource of clinical knowledge guidance and tools, available via KP’s Epic Systems electronic medical record (EMR). The pathways are represented as intuitive, graphical, clickable process diagrams, with additional clinical content available as hover text. CL uses standard Epic interfaces to receive contextual information when accessed from a patient encounter. When the physician browses the CL oncology pathway and selects a treatment recommendation, CL returns to the EMR with the specific treatment plan queued up for ordering. We began initial deployment of these inter-regional pathways in Feb 2020. We combined EMR data with CL data to understand the impact of this clinical decision support. Results: We experienced dramatic uptake of oncology clinical pathways despite offering minimal training and no external incentives. KP orders over Beacon treatment plans annually in the clinical conditions supported by our pathways. In the first quarter of deployment, clinicians ordered 9% of these protocols through clicking on CDS in CL. Over the course of 2 years, we saw pathway-based ordering grow to over 75% of eligible patients. Conclusions: We find that we have made considerable progress toward our goal of having physician users consult clinical pathways decision support before ordering oncology drug treatment protocols. As with all clinical guidance, we would not expect 100% of patients to follow the recommendation, due to clinical variation and co-morbidity, but we find that by making clinical pathways easily accessible and actionable within normal clinical workflow, physicians are consulting the latest evidence in their treatment.